Your opinion of the Affordable Care Act (ACA) probably depends on what role you play in the U.S. healthcare system.
- Physicians and other healthcare providers seem to fear each and every new provision as it’s unveiled and are anxious about how to implement the requirements placed upon them.
- Hospitals are trying to stay ahead of the game (and their competitors) by forming Integrated Health Systems and Accountable Care Organizations, and purchasing physicians’ private practices.
- Consumers are attempting to navigate the system to take advantage of improved health insurance coverage or to obtain it for the first time.
- Businesses of all sizes are looking for interpretations of what the law says about employee benefits.
- Health insurance companies are evaluating in what ways they will participate and what that participation (or lack of) will mean to them in the future.
- States are trying to decide if they will accept federal money to expand Medicaid and Medicare coverage within their borders.
No matter who you are or what you think of healthcare reform, the changes in the ACA are going to affect you and there are more on the way.
Protecting Consumers
Most people aren’t aware that since President Obama signed the ACA into law in March of 2010, over 30 provisions have been implemented. The initial items were put into place throughout 2010 and were focused heavily on protecting healthcare consumers. These protections put the greatest amount of pressure on health insurance companies by limiting rate increases, restricting pre-existing condition clauses for children, regulating annual and lifetime payout limits, and mandating an appeals process for denied claims. Business owners are feeling that pressure too as they see increases in health insurance costs for employees. Along with consumer protections, the ACA also includes provisions for improving the quality of healthcare and lowering the cost.
Improving Quality
While many wonder how some of these quality improvements will be funded long-term, there is no doubt that consumers will benefit from them. Providing tax credits for small businesses, free preventive care such as mammograms and colonoscopies, prescription drug discounts of 50% for seniors, and physician and hospital incentives for their use of electronic health records systems are all costly pieces of the overall plan. In fact, the federal government has promised billions of dollars in federal funds to help rollout and enforce the guidelines of the ACA. In addition to new consumer protections, improved quality, and reduced costs, the act allows for more access to affordable care, which is geared mainly toward uninsured consumers.
Increasing Access
People who have had trouble getting health insurance and access to affordable treatment in the past include young adults forced off of their parents’ insurance, individuals denied coverage due to a pre-existing condition, and early retirees compelled to spend retirement savings before meeting the age requirement for Medicare. The ACA addresses each of these issues through state and federal programs designed to ensure that virtually no one is unable to receive care. It is estimated that more than 30 million previously uninsured Americans will enter the U.S. healthcare system by 2015. Already facing a physician shortage, this increase in healthcare consumers will definitely put a strain on physicians, medical groups, and hospitals all across the country.
One way the ACA attempts to address the physician shortage is by giving incentives to increase the number of physician assistants, nurse practitioners, and primary care doctors. Incentives include scholarships to encourage medical students to consider primary care as a specialty and to practice in underserved areas.
What Comes Next?
Obviously a great deal of the ACA has been implemented over the last several years, but there are more changes on the way. In 2013 we will see expanded funding for free preventive care for those who qualify for Medicaid as well as increased coverage for children who do not qualify. In physician offices, probably one of the most talked-about provisions is “Payment Bundling.” This is a program designed to encourage primary care doctors and specialists, hospitals, surgery centers, and other providers to work together to charge a flat rate for an “episode of care,” rather than the fragmented billing in place now. Bundling is supposed to control costs for Medicare and Medicaid while improving the quality of care for the patient. Many physicians and administrators see this as a challenge because traditionally these groups have not worked well together. Communication among the different entities has not been easy, and often they are in competition, making it difficult to trust one another.
In 2014 and 2015 Consumer protections again will focus on health insurance companies by prohibiting denial of coverage or the charging of higher premiums based on sex or any pre-existing condition and also completely eliminating annual payout limits. The provisions will make it impossible for insurers to individually underwrite policies, making carriers nervous.
The establishment of the “Health Insurance Marketplace” will make it possible for individuals and small businesses to have more choices for affordable insurance than ever before. The “transparent” nature of the Marketplace along with price regulations promises coverage when an employer doesn’t offer any. The details of exactly what the Marketplace will look like are not clear. In addition, the ACA timeline provides tax credits for consumers, increased tax credits for small businesses, and more funding for Medicaid. And don’t forget the requirement for every American to obtain health insurance.
Also on the subject of transparency, the ACA “Sunshine Rule” was recently announced by the Centers for Medicare and Medicaid (CMS), which requires manufacturers of drugs and medical devices or supplies to report payments to healthcare providers. This rule is intended to avoid conflicts of interest that may occur in these relationships and will begin on August 1, 2013.
One physician-focused topic is the provision coming in 2015 that will tie payments to quality of care. The emphasis will be on higher quality care rather than on volume of patients. While no one would argue with the logic, many providers are concerned about the method of measuring “high quality care” vs. “lower quality care.” The language in the ACA seems vague at this point. You can keep up with the ACA changes on the timeline found on the government’s healthcare website.
How are Physicians Affected?
Doctors are concerned about the changes that have taken place and anxious about changes ahead. They are worried about increasing patient loads, decreasing revenue, and expanding government involvement in their practices. As providers face changes in the healthcare system, they often experience changes in exposure to risks associated with medical malpractice and as a result have questions about their medical malpractice insurance. There is certainly a higher possibility of a medical malpractice claim when seeing a higher volume of patients. But what new risks are involved when a physician joins an Accountable Care Organization? Who will purchase Tail Coverage when a physician becomes employed by a hospital? We see doctors adding new procedures and opening new locations to help increase their incomes; will a malpractice insurance policy cover any of these changes? Or is a separate policy necessary?
These questions and many others can be answered by the experts at eQuoteMD. Please contact us for solutions to your ever-changing insurance needs.
